Contents

December 2011
CAMSS executive - Please feel free to contact your representative with any concerns or issues. Dr. Lloyd Maybaum, CAMSS president Phone: 403-943-4904 Dr. Linda Slocombe, CAMSS past president Phone: 403-861-8423 Dr. D. Glenn Comm, CAMSS past president Phone: 403-850-0718 Dr. Steve Patterson, PLC MSA president Phone: 403-943-5554 Dr. Arlie Fawcett, PLC MSA vice president Phone: 403-944-9842 Dr. John Graham, CAMSS president-elect & RGH president Phone: 403-221-4489 Dr. Douglas Thorson, RGH MSA treasurer Phone: 403-943-3557 Dr. Earl Campbell, FMC president Phone: 403-221-4459 Dr. Geoff Hawbodlt, FMC VP & treasurer Phone: 403-943-9900 Dr. Sean Grondin, FMC MSA past president and treasurer Phone: 403-944-8798 Dr. Mary Brindle, ACH president Phone: 403-955-2848 Dr. Candice Bjornson, ACH vice president Phone: 403-955-2952 Dr. N. Grant Hill, rural MSA president Phone: 403-938-1424 Dr. Wendy Tink, GP representative Phone: 403-258-3000 Dr. Ann Vaidya, GP representative Phone: 403-873-2352 Dr. John Barrow, CMS president Phone: 403-275-5112

Columns: From the president: As bad as it gets ------------------------------ 5 Editorial - Bully on you - here is my six and four plan --------- 6 And one more editorial . . . sort of! --------------------------------- 8 Comm post corner - The culture of intimidation - the culture of fear: a call to action. ---------------------------------------------------- 9 Feature: American healthcare - are we that different? ------------------ 12 News: CAMSS update -------------------------------------------------------- 10 Letters ------------------------------------------------------------------- 10 CAMSS classified ----------------------------------------------------- 10 AMA update -------------------------------------------------------------11 CAMSS AGM ---------------------------------------------------------- 13 Your mother would not be proud - Wash your hands! ------- 13 Call for FMC Outstanding Clinician Award nominations ---- 14

Contributing members Dr. Cheri Nijssen-Jordan, CPSA representative Phone: 403-955-7810 Sean Smith, director, practice management program Phone: 403-266-3533 Dr. Ronald J. Bridges, U of C rep 403-220-4245 Dr. Joanna Lazier, PARA rep Para-ab@shawbiz.ca Web site: www.CAMSS.ca Administration office, Glennis Brittain phone: 403-943-1270 Administration office fax: 403-476-8770

Vital Signs is published 11 times annually (not published in August) by the Calgary & Area Physician’s Association (CAMSS) www.CAMSS.ca Editor: Dave Lowery, bethere@shaw.ca, 403-243-9498 Advertising director: Bob d’Artois 403-540-4702 bobdartois@shaw.ca Editorial advisory board: Dr. Glenn Comm – glenncomm@shaw.ca Dr. Mark Joyce – mjoyce@ucalgary.ca Dr. Linda Slocombe – slocombe@shaw.ca Dr. Ian Wishart – ianwishart@shaw.ca Submissions: Vital Signs welcomes submissions (articles, notices, letters to the editors, announcements, photos, etc.) from physicians in Alberta. Please limit articles to 600 words or less. Please send any contributions to: Dave Lowery: E-mail: bethere@shaw.ca, tel: 403-243-9498. Vital Signs reserves the right to edit article submissions and letters to the editor. Deadline: The deadline for article submission to Vital Signs is the 15th day of the month for distribution the first week of the following month. Next deadline is December 15, 2011. Contributors: The opinions expressed in Vital Signs do not necessarily reflect the opinions or positions of the CAMSS or CAMSS executive. Advertising: Claims made in advertisements are not verified by CAMSS and CAMSS assumes no responsibility for advertising accuracy. © 2011

Vital Signs accepts advertisements from members and non-members. For advertising rates, please visit: www.CAMSS.cc and download the rates from the Vital Signs page. For more information please contact Bob d’Artois, CAMSS advertising director. P. 403-540-4702 bobdartois@shaw.ca

On the cover: Irene Pfeiffer (left) receives a College of Physicians and Surgeons of Alberta award from Dr. Cheri Nijssen-Jordan at the CAMSS AGM held November 9. Photo by Dave Lowery.

Vital Signs December 2011 • Page 4

From the CAMSS president
ust when I thought that the system had passed its nadir of dysfunction, new information gob-smacked me shortly after the release of last month’s Vital Signs and my article regarding the five-year action plan for mental health. At a provincial meeting on November 2, a senior AHS executive addressed the concerns that I had raised regarding the lack of engagement of physicians in the development and announcement of the five-year plan. This has since been shared amongst ZAF and ZMAC members and so by now I imagine is becoming common knowledge. Whereas I noted in last months article how unengaged physicians were feeling with respect to this plan, it was revealed that AHS was feeling similarly unengaged. Moreover, it was suggested that AHS was only marginally aware of and involved in the production of the five-year plan. They were completely caught off guard when the plan was released to the press on September 12 and were not made aware of the budgetary implications of the plan including AHS accountability for numerous issues. In the end, it would seem that the plan was hatched principally by AHW and the former health minister’s office (Gene Zwozdesky). It was precipitously presented in the press conference of September 12 and deceptively wrapped with the AHS banner. This apparently was a serious point of aggravation for AHS so much so that the AHS board has apparently expressed objections and raised concerns. Thus, it would appear that we have a brilliant example of the right hand not knowing what the left hand is doing but, worse than that, the right hand undermining the function of the left hand. These depths of dysfunction are truly unfathomable. For AHW and the minister’s office to arbitrarily produce and announce this plan without the full involvement or engagement of their operations and implementations partner, AHS, is completely inexcusable and laughably demonstrates how messed up our system truly is. In the end, AHS was left wearing the egg. AHS received the brunt of the criticism for the delivery of this plan yet seemingly had little to do with it. AHS, the organization that is desperately trying to engage health care workers, physicians in particular, was broadsided by the minister’s office and AHW. Now this is dysfunctional. How can AHS be meaningfully and effectively tasked with the delivery of health care services in this province if civil servants (AHW) and our elected representatives continue to directly intervene or make decisions that undermine AHS’ ability to coherently deliver those services? AHW may not be interested in engaging physicians but AHS certainly is. This entire saga speaks to what the Health Quality Council recently indicated as one of the problematic areas in the system (second interim progress report of October 27, 2011). It stated that there is a blurring of the boundaries between the Alberta government and Alberta Health Services. “Boundaries of authority, accountability and responsibility between the Alberta government (i.e. premier, cabinet, health minister, MLAs and government ministries), Alberta Health Services (i.e. governance, administrators and clinical operations) and the regulatory bodies (including physicians) were blurred, confusing and inconsistent.” Given recent events, I whole heartedly agree. Moreover, I’ve previously commented on these problems. The government agenda is motivated by political machinations. The AHS agenda is to deliver quality health care services that are timely and on budget. Very simply, political motivated decision making and the AHS agenda do not compliment each other.

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As bad as it gets I draw your attention to my article in the June 2011 issue of Vital Signs, in which my “Firewall” article suggests the need to ringfence or build a firewall between politicians and AHS. The fiasco of the five-year action plan for mental health underscores the relationship problem between the Alberta government, AHW and AHS. What it particularly highlights is the need for change. I am sincerely hoping that in February, the Health Quality Council’s final report will provide us Dr. Lloyd Maybaum, with some direction in this regard. CAMSS president Some believe that AHS is Phone: 403-943-4904 simply trying to perform damage control by suggesting that they were largely not involved in the development of the plan. But I tend to believe the explanations posited by AHS executive for two reasons. First of all, during the September 12 press release, when asked where the funds would be derived in order to pay for the plan, the (former) health minister apparently performed the wide mouthed guppy as if he had not taken this into consideration. In the end, he feebly suggested that they would look into the matter over the ensuing months. Secondly, the deafening silence of AHS following the announcement of the plan suggested that something was up. The lack of communication with physicians and psychiatrists in particular, aggravating as it has been, immediately becomes understandable if you consider that AHS was largely out of the loop with respect to the development and announcement of the plan. How do you respond to a plan that you had little to do with and then, what do you say to the possibly affected clinicians? It certainly must be tough for AHS executives to swallow this one. Before I excuse AHS administrators of all culpability I must note that after the plan was announced on September 12, regardless of having foreknowledge or not, it became incumbent upon someone within AHS to demonstrate leadership, to organize the troops and convey some sort of messaging to the affected physicians as soon as possible. Granted, after being broadsided by this plan it would take some time to organize a coherent response and approach to the plan but at the time of writing this article – over two months after the press release, psychiatrists continue to wait for some form of official explanation or reassurance with respect to what this plan is all about. AHS may get a pass since they were not engaged by the minister’s office with respect to this plan but as time passes and no one steps up to engage physicians and provide some form of explanation AHS is beginning to look more and more lackluster and rudderless. Delineating boundaries of authority, accountability and responsibility is long overdue in this mess known as health care in Alberta. If the Health Quality Council cannot get us there then a full public inquiry must be demanded by all Albertans.

Vital Signs December 2011 • Page 5

Editorial
Bully on you – here is my six and four plan “Galen went to Rome in 162 AD and made his mark as a practicing physician. His impatience brought him into contact with other doctors and he felt menaced by them. His demonstrations there antagonized the less able and original physicians in the city. They plotted against him and he feared he might be driven away or poisoned so he left the city.” Wikipedia By Dr. Lloyd Maybaum towards physicians during our current negotiations. This underscores yet another form of physician intimidation. Dare to speak out or rock the boat and we will get you in negotiations. Further to this argument, I do not doubt that the minister’s office will delay the conclusion of negotiations until after the next provincial election. This way, physicians will have less ability and sense of security to fight back. To this, I throw the gauntlet to the ground. Given the spectre of physician intimidation in this province, this government should, and must, conclude negotiations as soon as possible. All Albertans should demand this. It is not too far a stretch to suggest that the government is trying to hold physicians ransom and keep us quiet until after the election. To this I say that it is time to fight back. Into this scrum I introduce my six and four plan. Physicians, brace yourselves. This will require our wallets since money is the ammunition with which we will fight. Phase one of this plan starts right now. I am asking physicians to make a $400 donation to their political party of choice. I do not care which party you donate to, just make it $400 so that your name will go on record and the parties and the government will see that we mean business. If you are fretting about the cash outlay, bare in mind that it is tax deductible and will only cost you $150. Phase 2 is the clobbering knock-out punch that we will deliver if the government does not conclude negotiations before the next provincial election. In phase 2, we will coordinate our political donations to only one or two identified political parties but this time each of us donating $600. If the 98 per cent of physicians that are members of the AMA participate in this action plan then the benefactor(s) stand to gain millions of dollars. If the government does not conclude negotiations prior to the election they might be very disappointed to see such donations end up in the coffers of the Wildrose or Liberals. As a profession, we are tired of being kept quiet in a box when all around us we can see what is wrong with the system. This government needs to resolve the negotiation issue and demonstrate some good faith. Physicians have not been asking for much. Mess around with us much more and we are going to bite back. Ladies and gentlemen – prepare your cheque-books. If we end up requiring the combined $1000 donation it will actually only cost you a net $450 after your tax deduction. That is $50 less than the AMA special negotiations levy. Political donation sites are as follows and all accept credit cards. I have made my $400 donation but I am not going to tell you to whom until and if we require phase 2. Ladies and gentlemen, let’s get involved and get active – politically active! www.wildrose.ca www.albertaliberal.com www.albertaparty.ca www.albertandp.ca www.albertapc.ab.ca

et us cast a longing look at September 2010 when all things seemed to be fine regarding physician relations with the government and AHW. This seemingly quiet tranquility was suddenly shattered by the advent of the good doctors, Paul Parks and Raj Sherman. The verdant pastures of collegiality between physicians and elected representatives would never be the same. The government became battered and bruised by headlines of ER waits, allegations of waitlist malfeasance and patient misadventure. All this, while negotiations for a new trilateral fees agreement with physicians churned in the background. Initially, negotiations seemed to be going well, that is, prior to October 2010 and the pugilism directed towards the government over healthcare. Then, low and behold, negotiations all of a sudden went awry. In fact, the about-face by the then health minister and AHW was no less than stunning. All of a sudden the AMA seemed to be facing broad based anti-physician sentiment. Negotiations soured despite the fact that physicians were not asking for much. We respected and appreciated the current economic environment and were willing to accept zero percent increases for the first two years with a mere cost of living increase in the third. This, however, would not satiate the need for the pound of flesh that the then health minister and AHW wanted from physicians. No, they handed a proposal that would see every primary care physician stand to lose upwards of $35,000 and that would rend a variety of physician benefits including the physician support program that provides counseling and emotional support to physicians and their families. I must ask – why the sudden change of tone in negotiations? Looking at the timing and the manner in which events have unfolded in the past year there appears to be a striking pattern. Perhaps the government was feeling betrayed or indignant by physicians finally rising up to cast aside their muzzles and yokes of restraint. Coincidentally, AHW and the minister’s office decided to extract their pound of flesh for the impudence physicians demonstrated by speaking out on behalf of patients. Et tu, brute? Were physicians stabbed in the back for speaking out? The portrait painted by the previous year’s events certainly suggests that this is exactly what transpired. The media scrum eventually moved from ER waitlists to that of allegations of physician intimidation: intimidation that was recently affirmed by the Health Quality Council interim report. As I mentioned during my AGM address on November 9, I would like to suggest that to the growing list of examples of physician intimidation, we must heap the brutal stance that AHW and the minister’s office adopted Vital Signs December 2011 • Page 6

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Vital Signs December 2011 • Page 7

And one more editorial . . . sort of!

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Dawn of the undead zombie politician

By Dr. Lloyd Maybaum Lich king Lie-fert! He was indeed alive (in undead fashion) but had somehow taken control of Laura! Lie-fert in power and somehow now in control of the treasure – ministering to the finances of the resurrecting hoard! Oh, the agony of the people. Frozen like rigor Morten, Laura was unable to continue the cleansing of the locker room crypt. There was no longer a wizard, a Zwoz to save us – after all, he was just a myth, for too many times he had called forth the Eagle. What despair was to fall across the land? What was to happen to notions of truth, justice and an inquiry? Noble notions once again hanging on the brink of the abyss. Where was our Laura now? Alas, our land would need a new hero but who could step bravely to face the assembly of zombie minions? Who was to be the new hero of the land? Just when all seemed lost, in the distance a sound was to be heard. A sound of hope, of a new beginning, of cavalry just over the hillcrest to save the people of the land from the evil zombie hoard. To some, the sound of a bull crashing amongst china but to others the sound of mechanized resistance coming from the left flank. The sights and sounds of a Sherman tank. To others listening carefully, a quiet bruit was to be heard building to a crescendo with the steady beating of a drum, the sinus rhythm of forged steel, hammer meeting anvil, striking libertarian blow after libertarian blow. The Smith, forging the one sword, the Vorpal Sword of the Rose that one day will glow a brilliant shade of green in the presence of undead. Beware zombie hoard. You may have taken our Laura, but the Sherman tanks are rolling. The Smith is sharpening the edge of the Rose. The sequel to our first act has yet to play out. Watch for it. It is coming soon in the next eight months. We have a new Laura, the Smith wielding the glowing Vorpal Sword of the Rose and she is immune to the dark magic of the Lich King Lie-fert. She will not be zombified. She will not take undead prisoners. The column of Sherman tanks is building. Beware zombies, beware . . . .

hallenged to include a reference to zombies in one of my articles and ready to take up a challenge I present a screenplay, of sorts. We must always remember, however, that the truth is sometimes stranger than fiction . . . . Our play begins with our star, Allison Pinkford. Ally, making her appearance as the heroin Laura Croft – Tomb (and locker room) Raider. She was prepared to challenge the legions of the political undead led by the Lich King Lie-fert. In her debut, our version of Laura would strike blows for truth, justice and an inquiry, raising our eyes and hopes from laborious toil. She would boldly cross (s)words with the undead locker room overlord, Edstella, declaring support for a public, judicial inquiry and a sweeping of the old locker room ways. The undead cronies cracked and groaned in response to this declaration, none conceiving she had a chance against the assembled hoard. Brandishing her keenly honed political axe she swung, dodged and parried her way, bounding and twirling in a dazzling array of bravado, cunning and opportunism – human rights against the undead. Leaping into the fray as a super charged ninja warrior she bounded from issue to issue briefly lighting atop friend and foe as she battled the hoard. A step on Raj, a push off from Danielle, a flip and a rebound, culminating in a somersaulting punch landing – squarely facing Gary, the Warlord of Mars. Sensing the power of the locker-room crypt and a formidable presence of undead, Laura nursed her wounds and educated herself unto Machiavelli. She blew the horn of Harper which echoed across the land calling forth the disciples of Horner. In the final scene of Act One, the undead are finally laid to rest with Laura standing atop the mound declaring victory over the zombie hoard. The awake, the aware and the living had finally won the day and all were rescued from the clutches of the locker room political zombie hoard – or so it would seem . . . . Crowned the new living queen she raised the chalice on high to declare a new dawning across the land and all would cheer. But with the undead, being undead, there remained a scurrying in the darkness .... As she drank blithely in celebration of her victory unknowingly the zombies had not buried their hatchets along with their secrets. Nay, as Laura shone the flashlight amongst the crypt and locker room relics, she found her chalice was not filled with light sweet, crude though it was, but instead, a form of drink crystal from which she drank deeply.

Charmed by the forked tongue of Lie-fert, her vision immediately began to change. Our heroin choked, her eyes glazed and shrunk as she gasped at what was revealed in the inner sanctum of the locker room crypt. Then, through the freshly tilled soils of the political graveyard a gnarled, twisted unscholarly fist thrust itself into the twilight. The undead corpse declaring through a demonic cackling voice, “there will be noooo . . . inquiry . . . .” Shocked, the people of the land quickly realized that Laura, the princess of change and righteous determination had somehow become tainted with the infective – zombified by the Vital Signs December 2011 • Page 8

The Comm post corner

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The culture of intimidation –The culture of fear: A call to action Due to press deadlines, the new plan by AHS for regular evaluations of all physicians is, I am afraid, an implement that could easily be used by rogue managers to intimidate physicians. I was made aware of this new wrinkle just days ago at the Peter Lougheed Center Site Council, so I have no choice but to send it to the printer before I have all the details. That said: As a general principle, the following items (at a minimum) should be a part of due process: 1 – A document that clearly articulates, Dr. D. Glenn Comm, in simple language, the terms and CAMSS past president conditions by which physicians are to glenncomm@shaw.ca be evaluated. 2 – The right of a physician to have a choice of who does the evaluation in the case where there has been prior disagreement between the person doing the evaluation and the physician. 3 – Checks and balances that are being contemplated, and the avenues with which to appeal a decision. There MUST be appropriate physician input BEFORE any changes are implemented In closing, I have a have a request/challenge to Premier Redford. Ms. Redford, you were in support of a public judicial enquiry into physician intimidations when you were running for premier. Now would be a GREAT time to call that enquiry. Let us get the stories out, deal with the perpetrators, put into play the needed safety mechanism to prevent a repeat of things that have happened in the past, and THEN ALLOW US ALL TO MOVE ON! It MUST be a judicial inquiry, the HQCA is NOT an option. There MUST be protection for those who have testified, and with consequences meted out to those guilty parties who have perpetrated these wrongs. Only then, with these issues finally out of the way, will we be ready to move ahead. That accomplished, we could then start moving forward in Alberta healthcare. Your minister of health is well versed in our medical system and has, in the past, been a good listener. I would hope that, with no cloud hanging over many of us, we could change our view from looking back into the past, to looking forward to what is really important: providing excellent care and to making patients our first priority . . . every patient, everywhere. As always, your comments, criticisms, praise and poisoned darts are all welcomed at: glenncomm@shaw.ca

ne of the last important decisions made during my term on the Alberta Medical Association (AMA) board of directors was to call for a judicial enquiry into physician Intimidation of doctors in the province of Alberta. The request was denied and the government chose to await a report from Health Quality Assurance Council of Alberta (HQCA). As much as this council is well meaning and earnest about what they are doing, their committee is constituted under Alberta Regulation, 130 /2006 Regional Health Authorities Act. As such, I believe that it would be a stretch to view them as an independent and non-partisan. Before I go into further detail, let me be clear about one thing. This story is also NOT about the hundreds of decent, dedicated people in administrative positions who are honestly doing all they can to keep our teetering system upright for a bit longer. This IS however, a story of how the lives of many good doctors have been damaged by administrators, including those at the highest levels of AHS. The abuse continues at many rungs at lower levels on the organization charts. There has been a culture of intimidation that has been allowed to persist within the former Calgary region to this day. Friends and colleagues have had their lives destroyed. Some of these abuses have lasted over a decade. I recently spoke to the spouse of one traumatized individual, whose falling out with a department head had, I thought, been sorted out a decade ago while I was still attending medical advisory board. I was chagrined to find that the climate in their department was still at a point where this physician was still not practicing medicine. I know of individuals who have spent thousands of dollars defending themselves from gestapo like accusations that turned out to be without merit. Also, personality differences, with NO clinical competence problems have been used by a department head to make a physician’s life miserable. I appreciate that some people might be sensitive to the term ‘gestapo tactics.’ If so, I am sorry to offend you. BUT I must also say, a few of the actions that have been dealt to certain ranking individuals during the various iterations of Calgary regionalization fit the bill. I have had to deal with the outcome of some of their egregious actions. There IS a culture of fear in the Calgary region. Dave Lowery can attest that he regularly gets e-mails from physicians telling about issues they are dealing with but who are so afraid to have their names published their stories remain untold. For many years Ward Flemons has done a wonderful job of creating a culture of patient safety in the Calgary region. I propose, that it is time for a culture of physician safety: safety to do our jobs without intimidation, safety in the knowledge that we cannot be dispensed of by the vagaries of an administrator`s whim, the safety of knowing that there are FAIR processes to deal with disputes, the safety of knowing that an honest disagreement with a superior on an issue cannot be grounds for dismissal . . . etc.

Vital Signs December 2011 • Page 9

CAMSS update
y, how time has flown. It is hard to imagine that it is the festive time of year again. CAPA, if you have not already heard, has now morphed into CAMSS. This transition was a huge undertaking and now, is mostly complete. All that remains are a few changes in banking and accounting and all will be in place. At this point, our biggest challenge will be to maintain the membership. As I am sure you are all aware, this was never really a concern for my predecessors since membership and dues in Calgary had always been mandatory until the advent of AHS. We all know that dues are now voluntary and now our paid members represent only approximately 50 per cent of eligible physicians and practitioners. In order to maintain the membership your CAMSS executive have been doing some brainstorming and I have some specific projects that I will be working on in the coming months. In an effort to contain costs we are also considering morphing Vital Signs into an ebook format that can be downloaded and viewed on ebooks and iPads. We are also planning to step up to the social media age by embracing Twitter and Facebook. I have to confess that I am no whiz with social media but we plan to go live with these applications on January 15. Employing social media may be very important if we are to engage the younger generation of physicians. So much has transpired in healthcare over the last year that performing a recap will not do it justice so I will focus on the prominent issue at hand, that of physician intimidation. Much has already been said in this regard but for me, I worry about a drive to emphasize the number of physicians that have been intimidated. For instance, some would suggest that if it was only 20 physicians “it’s really no big deal.” What if it were 50 physicians? I ask, at what number does it become a big deal? Does it become a big deal if it were 100 physicians or would it take more like 1000? Let me propose that if even one physician went through a process whereby their license was suspended or they lost their privileges because they spoke out on behalf of patients then that ONE incident is a very big deal. Physicians talk to each other and maybe we do some fear mongering amongst ourselves. Thus, it may only take one or two high profile and public cases of physician intimidation to cast a pall over the entire profession. We all remember the case of Dr. David Swan and who could forget the case of Dr. John O’Connor who publicly surmised that the development of the oil sands was linked to higher rates of cancer in the northern Alberta Town of Fort Chipewyan. So the message to those pundits that want to chalk the problem up to numbers, let me underscore, numbers do not tell the whole story. No matter how few or how many examples there are, I argue that even one is too many. Elsewhere this month I provide a shocking update on the story I wrote about last month. I introduce my six and four plan and finally, we visit with zombies. Albeit, a bit out of season who can resist zombies? Given the season, lets try to laugh, to unwind and to spend some time with friends and loved ones. Park the health care woes aside, if but for a moment, put your feet up and take some time for yourselves. Happy holidays everyone and let’s be careful out there. Vital Signs December 2011 • Page 10

Letters
Kudos for telling it like it is! I read with interest Lloyd Maybaum’s November 2011 column about the lack of physician engagement by AHS in crafting a 5-year action plan for addictions and mental health. Congratulations to Lloyd for stating it like it is!! Despite what was said by AHS executives after the Health Quality Council review, there remains a lack of awareness within this organization that physicians are key stakeholders. The sad irony here is that most physicians strongly share and support the AHS core values of quality and sustainability. Many, if not all physicians, want to work cooperatively with AHS for the betterment of care; our input can add great value to planning. Like Lloyd, I am uncertain whether repeated episodes of marginalization should make us angry, or not surprised. To not engage physicians in policy decisions or future planning is a profound lost opportunity. At what point do repeated instances of a behaviour become an organization’s culture? Sincerely, Paul Petrasek, MD FRCSC

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By Dr. Lloyd Maybaum

CAMSS classified
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AMA president’s letter

AMA update

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Health quality council validates allegations of physicians being intimidated AMA and CMA make joint submission to HQCA review panel

Interim report of the Health Quality Council of Alberta On October 27 the Health Quality Council of Alberta (HQCA) issued “its second, interim progress report related to its independent review of the quality of care and safety of patients requiring access to emergency department (ED) care and cancer surgery and the role and process of physician advocacy.” According to HQCA: “Excessive ED wait times put the quality of care these patients received at risk, in part by reducing the safety margin of the care that was able to be provided.” However, once patients were assessed by a physician, HQCA “had no concerns about the quality of care provided to patients notwithstanding the crowded environment where the care was delivered.” The interim report clearly supports allegations of intimidation that led to HQCA’s inquiry: “A number of physicians have described life- and career-changing outcomes that they attribute to their advocacy efforts. These include having hospital privileges affected, feeling ostracized by peers, and having contracts for services being altered or cancelled, which in some cases limited their options for remaining in the province. Some have elected to leave the province to seek work elsewhere.” AMA and CMA present to review panel The Alberta Medical Association (AMA) is on record as supporting a public inquiry into physician intimidation. Having said that, we also committed to providing commentary in the process of the HQCA review, particularly given that the status of a public inquiry remains uncertain. Regarding the public inquiry Premier Alison Redford promised during her leadership campaign, we will wait and see what she proposes. On November 10, Canadian Medical Association (CMA) Past President Dr. Anne Doig and I met with the HQCA review panel to make a joint submission on the subject of physician intimidation. What Dr. Doig and I hoped to bring to the discussion was a collective voice for our associations. The panel has heard many individual stories. By providing a high-level perspective and a larger scope of discussion, perhaps our submission will serve to help weave together many loose threads. The full submission is on the AMA website: http://www. albertadoctors.org/PresLetter/amacma_submission_hqca The environment of intimidation The AMA has heard from a significant number of members who related instances of intimidation experienced in the course of advocating for patients – and the severe personal and professional impact these events carried. Here are some highlights:

There is no other function more important to the vocation of medicine – and the spirit of Patients First® – than advocacy. Physicians need to feel they can perform this duty without fear of reprisal from Alberta Health Services (AHS) administrators or government. Patients also need to feel that their concerns are heard! The public will accept that hard choices have to be made every day in health care, but only if they feel they have a way to provide input and have their views heard. Physician input has not been sufficiently utilized in recent years. The system evolved into one where even constructive criticism was feared and ignored and disengagement of physicians became the norm. It was an environment of explosive change and chronic instability that contributed to this state: • The 2008 formation of AHS and the early, rapid centralization of administration. • Disruption or termination of local medical staff and administrative relationships. • A general divorcing of front-line input from administrative decision-making and governance. • Increasing demand for services as health care funding decreased in many areas and wait times increased. • Uneven and ad hoc protection for advocacy activities under nine different sets of regional medical staff bylaws. • Confusing messages from AHS about the appropriateness of physician advocacy 1. The early, soon-to-be-revoked, AHS code of conduct that was widely viewed as means to muzzle those who spoke out. 2. The absence of appropriate structures and processes for advocacy. When physicians did not know where to turn when advocating for patients, the result over time was misunderstanding and distrust. Occasionally, physician groups felt compelled to go public with concerns. At the point where media coverage and public attention created sufficient static, Alberta Health and Wellness (AHW) sometimes supplied funding to critical areas. This had the effect of encouraging advocacy outside of regular channels, while the system still tolerated administrative bullying and intimidation in other areas. A late, but important, factor of the chronic instability in the environment was the expiration of the eight-year trilateral master agreement between AMA, AHS and AHW on March 31, 2011. As we all remember, during last year’s negotiations – and at the height of public attention to the issue of physician intimidation – government made threats against valued programs. Negotiations continue today and government has extended the programs to June 2012, but physicians remain without a contract. Reaching a new agreement must be a priority in order to restore stability, trust and understanding! Vital Signs December 2011 • Page 11

CAMSS appreciates the funding support from AMA to help with their monthly submission publishing costs.

AMA update . . . Contd.
Moving forward There are some opportunities today for supporting physicians with respect to advocacy. The provincial medical staff bylaws, jointly developed by AMA and AHS, entrench the right and responsibility of physicians to advocate for quality care without fear of reprisal. They also ensure that AHS processes and administrative actions must align with the CMA Code of Ethics and the College of Physicians & Surgeons of Alberta (CPSA) Code of Conduct. To otherwise move forward, our submission contains nine recommendations, a number of which deal with various issues relating to the bylaws and ensuring their uniform application to all medical staff. We also propose that: • There is still a gap to be filled in policies detailing how complaints will be handled regarding administrative matters that involve administrative leaders. More clarity is needed to determine when a complaint against a physician shall be referred to the CPSA. We believe that AHS has used referral too frequently, in lieu of appropriately managing complaints involving physicians. It would be useful to explore an expanded role for the Alberta ombudsman, potentially reporting directly to the legislature, possibly as a final point of appeal beyond the bylaws for resolution of unusually complex cases. Greater accountability should be built into the system. In every facility and AHS zone, physicians need to know to whom they can turn to get results when they are advocating for patients.

American healthcare - are we that different?

Last month was part one from the interview and questions we asked two Washington, DC physicians to determine if Canada and the American health care system is really that different. This month, in part two, Matt Poffenroth, an American-medical-schooleducated Calgarian, responds. Poffenroth is regional medical director, National Capital Region, Johns Hopkins (JH) Community Physicians and an internal medicine specialist. Vital Signs: Could you help us understand why the Johns Hopkins School of Medicine, which on its website declares that “modern American medical education started at Johns Hopkins over a century ago,” has no academic department of family medicine? Dr. Matt Poffenroth: The traditional part of JH, which is the academic medical centre, has not promoted primary care because the institute is about true academic research and is Above: Dr. Matt Poffenroth much more specialty focused. And that’s what they have done for decades. However, they have been providing community based primary care for the past 20 years under the Johns Hopkins Community Physicians department. There’s a paradigm shift happening at JH where they want to be more than just an academic medical centre and want to be a true clinical delivery system. And to do that they have to provide more primary care which is where JH is focusing more. They are expanding into the DC region as part of JH’s effort to be part of the delivery system in community based hospitals. It’s a big shift in culture for JH. Most academic medical centres don’t do that. Vital Signs: What are some of the risks to Obama’s proposed health reforms, in your opinion? Dr. Matt Poffenroth: The main premise of reformed health is to offer more health insurance, bring health insurance to the 32 million Americans who don’t have it. If you were to ask Obama what the main benefit is, he would probably say that. At the same time that is also the risk. The system already doesn’t have enough primary care physicians so when you add another 32 million people . . . who’s going to provide that care? It’s a potential benefit and risk at the same time. Massachusetts passed state health care reform where they mandated everyone in the state had to have health insurance or pay a penalty. It was incredibly successful in getting everyone insured but the wait time for patients to see a primary care physician went from three weeks to about four months.

The Canadian Medical Protective Association recently made a very good comment about the mutual responsibilities of advocacy. “In the interests of patient care, health authorities and hospitals should be encouraging – and not discouraging – reasonably voiced perspectives, even if these views are contrary to their own. For their part, physicians have a responsibility to provide an informed perspective, in a reasonable manner that offers constructive recommendations for improvement.” I look forward, as always, to your comments and opinions. My email is president@albertadoctors.org.

Vital Signs December 2011 • Page 12

CAMSS AGM

O

n September 9, once again at the Glencoe club, the CAMSS AGM was held with a turnout of approximately 40 CAMSS members. Following Dr. Lloyd Maybaum’s CAMSS update (and no, things are not getting better with healthcare any time soon) Dr. Francois Belanger, the zone 5 medical director, gave an AHS state of the service update. Dr. Cheri Nijssen-Jordan gave a College of Physicians and Surgeons of Alberta update and also presented two awards - one to Irene Pfeiffer, former president of CPSA and the other to Dr. Ward Flemons for his work in quality and safety. Below, left, Dr. Francois Belanger and Dr. Lloyd Maybaum. At right, Dr. Ward Flemons and Dr. Cheri Nijssen-Jordan.

Your mother would not be proud – Wash your hands!
The hand hygiene compliance provincial, zone and hospital report was released in September. In summary, over 27,000 observations were collected across the province. Four common themes were found. 1. Hand hygiene compliance rates were poor. Provincially, the overall hand hygiene compliance was exactly 50 per cent. Hand hygiene compliance was highest in the central zone (75 per cent) and lowest in the Calgary zone (38 per cent). Hand hygiene compliance rates were lowest among physicians. Healthcare workers were grouped into three categories: physicians, nurses and other healthcare professionals. Provincially, nurses had the highest (54 per cent) compliance and physicians had the lowest (32 per cent) hand hygiene compliance. Poor compliance at high risk moments. Gloves were used inappropriately.

2.

3. 4.

Editor: at press time AHS was trying to put up the executive summary. Try here: www.albertahealthservices.ca/medicalstaff.asp

Vital Signs December 2011 • Page 13

Calling for nominations
Nominations are being accepted for the 2011 Outstanding Clinician Award for FMC primary site physicians. Please note the following information and the criteria required. Nominations should be made in a letter addressed to: Clinician award nomination committee c/o The Medical Staff Office, Room 154J Doctors’ Lounge, FMC Please include the following: • Name and department of the nominee • How you feel the nominee has met the selection criteria below • Name of person or persons nominating the individual • CV of the nominee if possible

Deadline for nominations is Friday January 31, 2012
The recipient of the award last year (2010) was, Dr. Paul Beck, gastroenterology, department of medicine Previous recipients of the award:

Dr. R.E. Hatfield 1991 Dr. N.B. Hershfield 1992 Dr. G.N.F. Hughes 1993 Dr. J.A. Williams 1994 Dr. E.A. Flagler 1995 Dr. P. Davis Elliott 1996 Dr. J. Dean Sandham 1998 Dr. Jane B. Lemaire 1999 Dr. Stephen K. Field 2000 Criteria • • • • • • • • • • • •

Dr. John B. Kortbeek 2001 Dr. Keith Brownell 2002 Dr. Martin J. Labrie 2003 Dr. Harvey Rabin 2004 Dr. Ronald Hons 2005 Dr. Lorne Price 2006 Dr. David P. Archer 2007 Dr. Andre Ferland 2008 Dr. Elizabeth McRae 2009

The nominated physician would normally have met many or all of the following: Provided exemplary health care: compassionate, advanced and effective. Promoted an atmosphere of respect and dignity in all individual relationships with patient and staff. Assisted with nurturing the staff to achieve their best. Promoted the development of outstanding students for health professions of the future. Contributed to innovative research evaluation and continuous improvement of hospital activities. Instrumental in sharing expertise and resources within our organization and with the communities we serve. Would normally have served the institution for ten years or longer and have been principally associated with the Foothills Hospital. Would have promoted safety and environmental responsibility both in the hospital and outside its confines. Would be recognized by the individual’s peers as a dedicated physician. May have received peer or community recognition of contributions outside of the Foothills Hospital, which reflect on the hospital in a positive way. May have made an especially significant contribution to departmental, divisional or hospital life.

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